A 2017 report produced by experts at the University of Manchester for the General Medical Council has concluded that burnout in doctors has devasting consequences on the quality of care they deliver. Burnout is defined as “a state of prolonged physical and psychological exhaustion which is perceived as related to the person’s work.”
According to the researchers, “doctors with burnout are twice as likely to make mistakes, such as incorrect diagnoses or wrong prescriptions.” They also report that “preventable harmful medical errors occur in 1 in 20 patients.” According to Dr. Maria Panagioti, who led the study, it shows “conclusively that the provision of safe, high quality patient care is severely compromised when doctors are physically, emotionally and mentally exhausted.” She adds, “Doctors are increasingly being asked to be superhuman, when they are not. They need care and attention that anyone would need when under such enormous pressure and that is just not happening.” These pressures are well-documented by junior doctors in surveys conducted by the General Medical Council.
Every year, the GMC invites more than 50,000 junior doctors to participate in a National Training Survey to give their views on their experiences of their training and the environments where they work. Large numbers do, there is a 95 per cent response rate from junior doctors. Since 2011 through to 2019, more than 40 per cent have reported the intensity of their workload as Heavy or Very Heavy. More than 50 per cent work beyond their rostered hours on a Daily or Weekly basis. As a consequence, since 2011 through to 2018, (the question did not appear in 2019), more than 20 per cent have stated that that their working patterns have left them feeling short of sleep when at work on a Daily/Weekly basis.
Junior doctors feeling short of sleep when at work, responsible for patient care, is an important matter but 2018 was the last year this question was asked. However, motivated by concerns that the pressures junior doctors face could lead to burnout, the GMC survey has included searching questions relating to this since 2018. In the 2 years since then, nearly 25 per cent have said they have felt burnt out because of their work to a High or Very High degree. More than half feel worn out at the end of the working day either Always or Often. Nearly 40 per cent find their work emotionally exhausting to a High or Very High degree. More than 30 per cent have stated that they are exhausted in the morning at the thought of another day at work Always or Often. Twice as many junior doctors who described the intensity of their workload as Heavy feel burnt out to a High degree, when compared to those who described their workload as About Right.
The GMC uses the survey results to ensure that junior doctors’ training is being provided in a safe, effective and supporting environment and that standards are met. It has concluded that intense workloads, regularly working beyond their rostered/contracted hours, and a lack of time to train due to clinical demands and system pressures, impacts on the health and wellbeing of doctors and on the standard of patient care they deliver. In February 2018, the GMC announced a three-year initiative to identify actions that can be taken to address workplace factors that affect mental health and wellbeing. This work continues.
Everyone should be concerned that we are damaging the health and wellbeing of the people we ask to deliver high quality health care. The GMC believes that creating training and working environments that encourage positive wellbeing is in the interests of both doctors and the patients they care for. But this is an inadequate response to such a serious problem.
What about the continuing impact of junior doctor fatigue and burnout on patient care?
Must the quality of health care be compromised until the GMC initiative is completed and continue until its recommendations are considered, debated over and slowly implemented?
How many years will this take and how many patients will experience harmful medical errors in the meantime?
Action must be taken as quickly as possible to reduce the workload and pressures which junior doctors face. Specifically, there must be a significant reduction in the number of hours which they work.
A 2009 study on behalf of the Warwick EWTD Working Group compared the rates of medical errors of a group of junior doctors working 48 hours per week with another working 56 hours per week. The study found that nearly 33 per cent fewer medical errors occurred when working 48 hours per week and there were also decreases in potential adverse events. Admittedly, this was a small study and it has its limitations. Its authors acknowledged that its results may not be applicable to all specialities. However, it indicates that a reduction in junior doctor work hours does not inevitably lead to a reduction in the quality of patient care – in fact, the opposite may be true.
The University of Manchester study shows that patient care suffers when doctors are physically tired and emotionally exhausted. This is not the fault of doctors. Year after year in GMC surveys, too many junior doctors have highlighted the intensity of their workloads, how frequently they work extra hours, and how sleep deprived they are as a consequence. Recent surveys show unacceptable levels of burnout. It is testament to their hard work and selfless dedication that, despite these challenges, they turn up each day to take care of us.
The health and safety of junior doctors and their patients is at the heart of our campaign. I ask you to support it and use the template letter when writing or emailing your MP, MSP, Assembly Member, or MLA.
We must not reward the commitment and dedication of our junior doctors with exhaustion and burnout. We must take better care of those who work so hard to take care of us. Well rested doctors deliver safer care for patients!